Recent veterans are entitled to free health care, but many don't sign up

Chris KnightThe Department of Veterans Affairs performs community outreach in a variety of ways in order to ensure that veterans get enrolled in health care programs available to them.

With a new generation of veterans returning from war, the Veterans Affairs health care system is adapting its outreach tactics to ensure they receive the medical care they’re due.

There are outings at ball games and sites set up through social networking services such as YouTube, Facebook and Twitter. And every VA Medical Center across the country has a team ready to help the service members returning from Iraq and Afghanistan, as well as special services for women veterans.

"We are out there all the time meeting with units, doing community education" to ensure veterans enroll for the services, said Gretchen Roberts, manager for the Lebanon VA Medical Center’s Operation Enduring Freedom/Operation Iraqi Freedom Program. "Veterans should not have to navigate the system themselves. That’s why programs like ours are in place."

The federal VA provides medical care and benefits to all enrolled veterans, with a range of preventive outpatient and inpatient services offered within its health care system. OEF/OIF veterans receive an additional benefit — five years of free health care in the VA system for any issue related to their deployment. As with other veterans, once enrolled in the system, they’re always in, but for issues not related to deployment or after those five free years, they may face co-payments.

"We typically have wide latitude in what we can determine is deployment related," Roberts added. "Even if it’s not deployment related, we can take care of your needs."

According to the U.S. Department of Veterans Affairs, of the 1.7 million who have served in the two theaters of operation, 1.02 million veterans were eligible for VA health care as of April 2009. A total of 454,121 have come to the VA for care, said the VA’s Terry Jemison. Of that number, nearly half are reserves and guard members.

"We have a large number of guard and reserves, and in many cases, they had to leave their workplace when their unit was called up," Jemison said, explaining some differences with veterans of past wars. "After being separated from active duty, they’ve returned to work and have health insurance from their job and other options.

"They get to the demobilization site, are anxious to get home and aren’t thinking a lot about their federal benefits," he added. "They’re feeling beefy, strong and healthy and don’t have a health issue. It’s one reason we do follow-ups. We try to track them down and remind them."

Aside from ensuring they receive benefits they’re due, the VA wants veterans to enroll to make sure they can quickly access health care for any problems that crop up.

"Many of the new vets coming home have issues with [post-traumatic stress disorder] and traumatic brain injuries," said Tom Wasco, Dauphin County Veterans Affairs director.

According to 2008 testimony from Disabled American Veterans before a Congressional panel, compared to other VA enrollees, OEF/OIF enrollees use half as much inpatient surgery and acute medicine but are expected to need three times the number of PTSD residential rehabilitation services. Also, they have greater needs for specialists in physical medicine, who might treat brain and spinal cord injuries, prosthetics and outpatient psychiatric and substance-abuse services.

Pentagon officials estimated this spring that up to 360,000 Iraq and Afghanistan veterans may have suffered brain injuries, including 45,000 to 90,000 whose long-term symptoms may need specialized care.

Nearly 37 percent of veterans treated for the first time at VA hospitals between 2002 and 2008 suffered from mental health problems, according to a study by the University of California at San Francisco and the San Francisco VA Medical Center released in July. Of those 303,223 veterans, nearly 22 percent suffered from PTSD; 17 percent were diagnosed with depression; 7 percent had alcohol problems; and 3 percent had drug problems.

At the Lebanon VA Medical Center, recent veterans are not seeking treatment for one specific ailment or medical condition over another, Roberts said.

"Obviously we are aware of the more common issues, but here it’s really all across the board," Roberts said. "Every soldier, every veteran has their own issues, and we try to be prepared for any of them."

To adapt to the changing face of the military, the VA operates a network of outpatient clinics — including one in Camp Hill — and allows enrollees to be seen at any VA facility across the country, not just their primary treatment facility. It also offers a women veterans program manager at each VA Medical Center nationwide to advise and advocate for women veterans, including coordinating all their health care services.

As the Obama administration has made a commitment to continue liberalizing income thresholds for VA services in the future, Jemison said the VA expects as many as 500,000 more veterans to enroll in the health system in the next four years. Already 8 million individuals are enrolled.

Veterans who have other avenues for health insurance, perhaps through employment or a spouse, can continue to use that coverage at doctors and providers of their choice, but to use VA benefits requires enrollees to use VA doctors and facilities.

"The VA is not health insurance, but a health system," Roberts said. "They can receive primary care through one of our doctors, through our dentists. We have providers trained to meet veterans’ unique needs."

Wasco, who has used the VA health care system for primary care since 1998, said, "It’s a good system. I have no complaints with VA health care."

Wasco’s office and its counterparts in every Pennsylvania county can help enroll veterans, connect them with other needed services and guide them through claims and appeals processes with the VA. But the first step is to enroll, he said.

"These guys get home and probably have a couple things on their mind that are not VA health care," he laughed. "They’ve been gone for a year, they’re getting debriefed and have their mind somewhere else. They told us [about the VA system] in the Vietnam era, but all I wanted was to get out."

That mindset has spawned outreach efforts beyond the traditional demobilization briefing. For instance, the Lebanon VA Medical Center held a third annual "welcome home" event for OEF/OIF service members, veterans and their families at a Harrisburg Senators game and the VA increased its presence online.

"We want to be there to meet whatever needs the veterans have, make it user-friendly and make it easy to access care so there’s no obstacles," Roberts said.

Special benefits—The VA also offers many special and limited benefits available to certain veterans or those in certain situations. It includes everything from Gulf War illnesses and home care to nursing home care and Agent Orange exposure.